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The CLTS approach

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What is CLTS?
Community Led Total Sanitation (CLTS) is an innovative methodology for mobilising communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation free).

At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral contamination continued to spread disease.

In contrast, CLTS focuses on the behavioural change needed to ensure real and sustainable improvements – investing in community mobilisation instead of hardware, and shifting the focus from toilet construction for individual households to the creation of open defecation-free villages. By raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease, CLTS triggers the community’s desire for collective change, propels people into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.

CLTS was pioneered by Kamal Kar (a development consultant from India) together with VERC (Village Education Resource Centre), a partner of WaterAid Bangladesh, in 2000 in Mosmoil, a village in the Rajshahi district of Bangladesh, whilst evaluating a traditionally subsidised sanitation programme. Kar, who had years of experience in participatory approaches in a range of development projects, succeeded in persuading the local NGO to stop top-down toilet construction through subsidy. He advocated change in institutional attitude and the need to draw on intense local mobilisation and facilitation to enable villagers to analyse their sanitation and waste situation and bring about collective decision-making to stop open defecation.

CLTS spread fast within Bangladesh where informal institutions and NGOs are key. Both Bangladeshi and international NGOs adopted the approach. The Water and Sanitation Programme (WSP) of the World Bank played an important role in enabling spread to neighbouring India and then subsequently to Indonesia and parts of Africa. Over time, many other organisations have become important disseminators and champions of CLTS, amongst them Plan International, UNICEF, WaterAid, SNV, WSSCC, Tearfund, Care, WSP, World Vision and others. Today CLTS is in more than 60 countries in Asia, Africa, Latin America, the Pacific and the Middle East, and governments are increasingly taking the lead in scaling up CLTS. Many governments have also adopted CLTS as national policy.

After initially being conceived as an approach for rural sanitation only, there have been a variety of adaptation, for example in urban and peri-urban settings, in schools and in post emergency and fragile state contexts.

CLTS in the SDG era
The need to achieve sustainable sanitation for all is an urgent one: 2.3 billion people still lack even a basic sanitation service. 600 million people have limited access to sanitation; ie they share with other households. Globally, 892 million people still practise open defecation. (WHO/UNICEF, 2017).  More research has brought to light the many wide-ranging negative effects of a lack of, or inadequacy of, sanitation facilities. There is a growing understanding that sanitation impacts on many interrelated human rights (Musembi and Musyoki, 2016). The realization that ‘shit stunts’, that OD, faecally transmitted infections (FTIs), poverty, and undernutrition reinforce each other, is gradually being acknowledged (.">Humphrey, 2009; Chambers and von Medeazza, 2014; Quattri and Smets, 2014 ; Spears, 2014). Research is also showing that poor sanitation is related to psychological stress (Sahoo et al., 2015; Steinmann et al., 2015), and can increase women’s vulnerabilities to water, sanitation, and hygiene (WASH)-related violence (House and Cavill, 2015). A lack of suitable facilities for menstrual hygiene management can result in girls regularly missing days at school (Roose et al., 2015). The growing recognition of the central role of sanitation for all aspects of human development has been mirrored in a UN General Assembly resolution which, in December 2015,1 defined water and sanitation as two separate rights for the first time, as well as in the Sustainable Development Goals (SDGs), which include the ambitious aim of universal access to improved sanitation by 2030, with targets that include the elimination of OD (UN, 2015).

Many countries are making sanitation a political priority, and some have set ambitious targets for creating ODF nations, some with detailed roadmaps of how to get there. While the recognition of the huge potential of sanitation for improving health, wellbeing, and child development provide important fuel for the drive to sustainable sanitation for all, achieving this goal is going to need significant and rapid change within the sector, particularly in relation to reaching the poorest, where progress has been by far the slowest. The 2017 JMP report (WHO/UNICEF, 2017) states that 'no SDG region is on track to achieve universal basic sanitation by 2030, with the exception of Australia and New Zealand, where coverage is already nearly universal' and that '9 out of 10 countries where more than 5 per cent of the population lacked basic sanitation in 2015 are progressing too slowly to achieve universal basic sanitation by 2030.' So the question now is, how do we harness the political momentum, commitments, money, promising innovations, and new technologies that have appeared in the sanitation landscape? We also need to ask, what will it take to turn them into effective long-term solutions?

CLTS and the changing landscape of rural WASH

The WASH landscape has been changing subtly but noticeably over the last few years. CLTS has proved most effective to date in tackling the sanitation challenge at scale, becoming more and more accepted, integrated into national policies, and used in a wide variety of contexts by a multitude of actors. However, the last few years have challenged the sector to look beyond the ambitions of the MDGs and examine who is not being reached by efforts to increase access to sanitation. Coinciding with or perhaps being instigated by the SDG’s focus on universal coverage and reaching the poorest and most vulnerable, the complexity of the challenges facing the WASH sector and with it, CLTS, have become clear. The WASH sector is recognising the need to become more diverse and cross-cutting in response to this complexity, with general acceptance of the need for a menu of different approaches that can either be integrated with one another or used in isolation. More and more, programmes and professionals are moving towards not being proponents of one approach over the other, but are instead arguing for the need to look closely at the context and situation to inform decisions about what approach, or cocktail of approaches and interventions, to use.  .

More information
You can read in more detail about CLTS in the CLTS Handbook (2008). To get an up to date idea of CLTS in practice the challenges as well as innovations that are at play, take a look at Sustainable Sanitation for all: Experiences, Challenges and Innovations. Many of the key issues and dimensions of CLTS in practice are covered by our Frontiers of CLTS: Innovations and Insights publication series. In addition, in order to learn more about the approach, look at the highlighted Key Resources. They provide a good starting point for your reading. If you are interested in the implementation and progress of CLTS in a particular country, take a look at the Where section. To get an impression of CLTS in action, check out the many films from different countries that depict triggering in communities, as well as discussing some of the successes and challenges of implementation. If you are interested in a specific topic, please search the Resources by key word or topic (eg urban, monitoring and sustainability, children and schools, etc).